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Feedback from patients on AHRQ's Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS) told officials at San Fernando, CA-based Northeast Valley Health Corporation (NEVHC) that they had a problem with access. It also allowed officials to focus on getting patients to see providers faster by improving their wait times to 15 minutes or less for nearly half their patients.

As a federally qualified health center (FQHC), the organization serves a predominantly low-income, minority population across its 14 sites in Los Angeles County. About half of its patients are children, and nearly one-fifth lack health insurance. Patients complained about waiting too long to see a clinician.

"Patients do have a choice," says Debra Rosen, NEVHC's director of quality and health education. "In Los Angeles County, there are other FQHCs, there are other providers. And we heard from our patients very directly the frustration with long wait times."

Responses to the CAHPS survey indicated that long wait times occurred frequently. When reviewing the survey results and the additional patient comments, NEVHC CEO Kimberly Wyard said she focused on the patient comments that accompanied the survey. "Sure enough, patients wouldn't have much to complain about if the wait time met their expectations," she said.

Starting in 2012, NEVHC used the CAHPS survey to learn more from its patients about wait time. NEVHC measured how long patients had to wait before being seen and how long their total visit, from entering the waiting room to leaving, would take. Management focused on reducing the time to see a clinician to 15 minutes or less and decreasing the total amount of time that the patient spent at the site.

"The CAHPS survey was one of the pieces that led us to focus throughout the organization on improving cycle time," Rosen says. "We knew this was a significant issue. CAHPS was able to quantify for us just how significant."

Using data from the CAHPS survey and a newly installed electronic health record system, NEVHC leaders pinpointed interventions including reallocating staff resources and not scheduling well-child visits first thing in the morning. System leaders found that when the first appointments of the day ran long, there was a cascading effect on the rest of the day's schedule.

By 2015, NEVHC instituted changes systemwide. The results: from the start of 2015 to the first quarter of 2017, total average cycle time was reduced from 82 minutes to 65 minutes; the proportion of patients with a cycle time under 60 minutes rose from 34 percent to 48 percent; and the proportion of patients seen within 15 minutes of appointment time rose from 38 percent to 47 percent.

Going forward, NEVHC's goal is to reduce the average cycle time to less than 60 minutes. Leaders are keenly aware that it will remain a challenge. "It's so hard to move that dial," Rosen says. "But as we work and keep focusing on these numbers, they're moving, and that's really rewarding."